Twitter Weekly Updates for 2011-07-04

  • U.N. Report Declares Internet Access a Human Right | Threat Level | Wired.com http://bit.ly/ivNke2 #
  • #saahe2011 officially over. It was a wonderful conference made possible by the participation of health educators from all over the country #
  • Papert http://bit.ly/mggi6R. Being a revolutionary means seeing far enough ahead to know that there is going to be a fundamental change #
  • Papert http://bit.ly/le70h7. The impact of paper in education has led to the exclusion of those who don’t think in certain ways #
  • @dkeats When people are “experts” in a domain they can be blinded to great ideas in other fields and so miss opportunities to drive change #
  • @dkeats Agreed. I’ve had to work really hard to convince people in my dept that I’m not the “computer guy”, I’m the “education guy” #
  • Innovation is about linking concepts from different fields to solve problems, its not about doing the same thing with more efficiency #
  • “How do you learn enough of the words to make sense of the discipline?” #saahe2011 #
  • Presentation by David Taylor on the use of adult learning theories #saahe2011 #
  • Jack Boulet speaking about the challenges and opportunities in simulation-based assessment #saahe2011 #
  • Mendeley Desktop 1.0 Development Preview Released http://ow.ly/1ueXSs #
  • Social media is inherently a system of peer evaluation and is changing the way scholars disseminate their research http://ow.ly/1ueXMA #
  • @dkeats Wonder if the problem has to do with the fact that much “ed tech” is designed by Comp Scientists, rather than Social Sci? #
  • @dkeats Also, people have the idea that LMSs have something to do with T&L, & then struggle when it can’t do what they need it to #
  • @dkeats To qualify, the problem isn’t resistance, its misunderstanding. The conversation always ends up being about technology #
  • There’s a huge difference between “learning” & “studying”, not in terms of the process but ito motivation & objectives #
  • @thesiswhisperer conf is for health educators, mostly clinicians, many of whom are amazing teachers but for whom tech is misunderstood #
  • In a workshop with David Taylor, looking at using adult learning theories #saahe2011 #
  • Blackboard is a course management system, it has little to do with learning. Use it for what its designed for #saahe2011 #
  • Trying to change perception that technology-mediated teaching & learning isn’t about technology. Not going well #saahe2011 #
  • Just gave my presentation on the use of social networks to facilitate clinical & ethical reasoning in practice contexts #saahe2011 #
  • Deborah Murdoch Eaton talks about the role of entrepreneurship to innovate in health education #saahe2011 #
  • Social accountability is relevant for all health professions (healthsocialaccountability.org) #saahe2011 #
  • Charles Boelen talks about social accountability at #saahe2011 keynote, discusses its role in meeting society’s health needs #
  • First day of #saahe2011 over. Lots of interesting discussion and some good research being done in health science education #
  • Concept mapping workshop turned out OK. Got a CD with loads of useful information…a first for any workshop I’ve attended #saahe2011 #
  • Many people still miss the point when it comes to technology-mediated teaching & learning. Your notes on an LMS is not teaching or learning #
  • At a workshop on concept mapping, lots of content being delivered to me, not much practical yet #saahe2011 #
  • Noticed a trend of decreasing satisfaction from 1-4 year, even though overall scores were +. Implications for teaching? #saahe2011 #
  • Banjamin van Nugteren: do medical students’ perceptions of their educational environment predict academic performance? #saahe2011 #
  • Selective assignment as an applied education & research tool -> gain research exp, improve knowledge & groupwork #saahe2011 #
  • Reflective journaling: “as we write conscious thoughts, useful associations & new ideas begin to emerge” #saahe2011 #
  • Change paradigm from “just-in-case” learning to “just-in-time” learning #saahe2011 #
  • Benefits of EBP are enhanced when principles are modelled by clinicians #saahe2011 #
  • EBP less effective when taught as a discrete module. Integration with clinical practice shows improvements across all components #saahe2011 #
  • Students have difficulty conducting appraisals of online sources <- an enormous challenge when much content is accessed online #saahe2011 #
  • Looking around venue at #saahe2011 10 open laptops, 2 visible iPads (lying on desk, not being used), about 350 participants…disappointing #
  • EBP isn’t a recipe (or a religion), although that is a common misconception #saahe2011 #
  • Prof. Robin Watts discusses EBP and facilitating student learning. EBP isn’t synonymous with research #saahe2011 #
  • “A lecture without a story is like an operation without an anaesthetic” Athol Kent, #saahe2001 #
  • Kent drawing heavily on Freni et al, 2010, Health professionals for a new century, Lancet. #
  • #saahe2001 has begun. Prof. Athol Kent: the future of health science education #
  • Portfolios and Competency http://bit.ly/jfFpfU. Really interesting comments section. Poorly implemented portfolios aren’t worth much #
  • @amcunningham I think that portfolios can demonstrate competence and be assessed but it needs a change in mindset to evaluate them #
  • @amcunningham will comment on the post when I’m off the road #
  • @amcunningham Can’t b objective as I haven’t used NHS eportfolio. Also, its hard 2 structure what should be personally meaningful experience #
  • @amcunningham Portfolios must include reflection, not just documentation. Reflection = relating past experience to future performance #
  • @amcunningham Your delusion question in the link: practitioners / students not shown how to develop a portfolio with objectives #
  • @amcunningham Also spoke a lot about competency-based education and strengths / limitations compared to apprentice-based model #
  • @amcunningham Very much. Just finished a 4 day workshop that included the use of portfolios as reflective tools in developing competence #
  • Final day of #safri 2011 finished. Busy with a few evaluations now. Spent some time developing the next phase of my project. Tired… #
  • Last day of #safri today, short session this morning, then leaving for #saahe2011 conference in Potchefstroom. It’s been an intense 5 days #
  • Papert: Calling yourself some1 who uses computers in education will be as ridiculous as calling yourself some1 who uses pencils in education #
  • Daily Papert http://bit.ly/jKlVmn. 10 years ago, Papert warned against the “computers in education” specialist. How have we responded? #
  • Daily Papert http://bit.ly/m7rfYY. Defining yourself as someone who uses computers in education, is to subordinate yourself #
  • YouTube – Augmented Reality Brain http://bit.ly/kcZWXy. When this is common in health education, things are going to get crazy #
  • @rochellesa Everyone needs some downtime, especially at 10 at night when you’re out with your wife 🙂 Seems like a nice guy, very quiet #
  • @rochellesa The large policeman he’s with isn’t keen tho. Mr Nzimande has asked 2 not b disturbed. Understandable when u want to chill out #
  • I’m sitting in a hotel in Jo’burg & Minister of Higher Education Blade Nzimande walks in and sits down next to me. Any1 have any questions? #

SAAHE conference, 2011 – day 3

Today was the last day of the SAAHE conference. Coming as it did immediately after a week of the SAFRI programme, I can’t say I’m not glad it’s over. It’s been an amazing experience though, mostly as a result of the wonderful health educators I’ve been fortunate enough to meet. Here are the last of the notes I took during the conference.

Simulation-based asessment: challenges and opportunities by Jack Boulet

Simulations used for summative and formative assessment, as well as curriculum assessment and patient safety

Need to know what health practitioners actually do, (i.e. procedurally), as opposed to what they know

Simulated (standardised) patients are good for some things but not others e.g. trauma

Performance measures:

  • Link measures to scenario events
  • Focus on observable behaviour
  • Incorporate multiple measures from different sources

Types of scores:

  • Explicit process
  • Implicit process
  • Explicit outcome

Checklist for assessing acute scare skills

  • Certain actions are more important than others
  • Sequence and timing are important

Checklists reward thoroughness

Training and quality assurance are important when it comes to assessment and ratings

Developing reliable and valid scoring systems is difficult

Important to identify and minimise errors of measurement

Peer review is essentially about getting a high number of opinions that over time will average out to be an accurate measure

Cases (simluations) are “vehicles” to measure skills

  • Who are the target examinees?
  • Specificity
  • Difficulty
  • Essential manoeuvres and questions?
  • Sampling from a domain (identify the domain)

Predictive validity” – Even with simulation, it’s difficult to establish predictive value → performance in the real world

Challenges:

  • Cost
  • Logistics
  • Setting standards
  • Interdisciplinary skills (e.g. measure doctor-patient interaction but not doctor-nurse interaction)
  • Integration

What is the societal cost of having providers with inadequate knowledge and skills?

It’s more interesting to measure how people lose skills / competence over time, than to measure how they acquire skills

Inferences concering competence are dependent on linking scores to performance criteria

How can we best use technology as part of current clinical / educational efforts?

  • Electronic portfolios
  • Online testing
  • Combined methods

Use of advanced technology to increase fidelity e.g. virtual reality, haptic systems

Students change behaviour when they know how they’re being assessed e.g. with checklists

Simulation studies using confederates (can this be done with students and “broken” equipment?)

Good teamwork is easier to recognise than it is to define


Making use of adult learning theories by David Taylor

Attended a workshop yesterday, which covered much of the same content

Behaviourism – consequences drive actions

Picking up the rules of a community”, “learning the rules of the game”, “what does it mean to be?

How do you learn “enough of the words” to make sense of the discipline?

Exploration of a model based on Kolb’s learning cycle:

Elaborate” new knowledge → consider all propositions and discard ones that are irrelevant, experts navigate this path quickly

  • Work out the most likely resources to refine possibilities
  • Actively participate in the activity
  • Refine the information into a hypothesis

Reflecting / organising:

  • Test – retest the hypothesis
  • Organise information into a “story” that makes sense to them
  • Teachers need to provide cognitive structures upon which students can build → scaffolding
  • Encourage reflection-in-action / reflect while doing

Feedback:

  • Students needs to articulate prior knowledge
  • Assessment is a form of feedback
  • Feedback can only be given when students have articulated / exposed their understanding
  • Teachers must be open to accept (and to act on) feedback from students

Reflect / consolidate:

  • Take on board the feedback
  • Reflection in the light of new knowledge and the learning process
  • Evaluate personal responsibility for learning
  • Teacher needs to provide opportunities for the learner to rehearse / apply new knowledge i.e. encourage reflection-on-action

Dissonance:

  • Using a challenge to help students make a conceptual leap by identifying / proposing an alternative concept that they had not considered
  • Is dissonance a way to help students move through Vygotsky’s ZPD?
  • Mezirow – “learning is a disorienting dilemma”
  • Can be created by manipulating”
    • Resources: should be appropriate, sufficient and relevant
    • Motivation (Knowles):
      • Intrinsic: adults learn because they need to know, have a self-concept as a learner, have life experiences, readiness to learn, orientated towards learning
      • Extrinsic: programme / curriculum, community of practice
    • Stage of development (Perry): Duality (“right and wrong answers and the teacher knows what’s right”) → multiplicity (“comfortable that in any given situation, there’s more than one answer, and that context is what matters most” – comfort in dealing with uncertainty)
    • Style of learning (Entwistle, Biggs): strategic, deep, surface ← how do you measure which of these is happening?

CoP (Wenger):

  • We don’t live or work (learn) in a vacuum
  • Everyone is part of a community
  • We only learn in community (does this mean that it’s impossible to learn independently?)
  • We develop as part of that community


Perceptions and experiences on community engagement as part of learning Student sessions. Points below taken from a variety of student presentations

Train of hope (Phulophepa)

Service learning, research and volunteerism: providing support to about 87 organisations in the area, entirely student run → builds confidence and experience, receive certificates for work done which are valued by future employers

Move from community service to community development

External evaluation bring accountability to projects

Most common health problem encountered by medical students on community-based learning placements is drug abuse

Community dynamics:

  • lack of medication
  • non-compliance
  • traditional healers
  • religion and beliefs
  • social problems

Patients’ stories are often heartbreaking

The patient is more than the illness”

Poor of the poorest”

Medical doctors and sangomas (traditional healers) have areas of overlapping practices and principles

As long as patients are living in this world, they are appreciated as human beings”

Challenge students to move out of their comfort zones

Community-based projects count for a very small percentage of the coursework grade, yet it takes an enormous amount of personal commitment and time, and is supposedly valued by educators

Language is a significant problem for student-patient interaction

Students conflicted when we tell them to think outside the box, but then have expectations for them to “do it by the book”

Does the institution learn as much as the students from the community experiences? When students report back to the institution, what changes do they experience as / if the institution responds? Does the institution respond?

Strategies to improve clinical teaching: a workshop

Photo from paukrus on Flickr

On Saturday I attended a workshop at Groote Schuur hospital that had the aim of providing “…clinicians with the opportunity to improve their ability to facilitate learning in clinical practice”. Objectives included improving the understanding of theories of learning, methods of enhancing learning and assessment practices and the role of assessment in learning. I was impressed with the number of clinical educators and supervisors (about 40) who gave up their Saturdays to attend. Here are my notes:

Learning in clinical practice

Brainstorming:

  • How do I learn? Immersive, pulling in additional material, alternative ideas, I need to see the big picture
  • How do I learn best? Personal, vested interest, answering a question of relevance, application to a relevant problem, can be associated with different sensory modalities
  • How did I develop “expertise”? Socially, conversation, discussion, sharing, questioning, choosing to “own” something, pushed out of your comfort zone
  • How does learning happen? Reducing to basic principles, commitment, dedication
  • When last did you learn something new?

Students feel lost and disorientated when first arriving on a placement, no matter how much they prepare, they still feel unprepared

Theory is linear, it’s neat and “tight”, whereas practicals are messy and untidy. So, theory doesn’t prepare you for practice, only practice does

Students should be allowed to make mistakes, but when a patients health and well-being are at risk, mistakes are problematic. Students want to be “right” (maybe because we stress how important it is that they get it “right”). Clinical skills labs are useful to address the problem of practising and being allowed to make mistakes. But clinical skills labs are expensive

“Learning” is the process of turning information into knowledge through engagement

Learning is about making meaning

Students struggle with theoretical concepts until they have the opportunity see / feel the concept in the real world e.g. low tone, ataxia

Learning happens by linking new ideas to older, established ideas, which is why our perceptions of the world are highly individual

What do we do to develop student, as well as professional identity. The notion that students are “socialised” into the profession

Once students cross a “threshold”, the learning experience opens up to them

Students sometimes know the words, but not what they mean

Many students have trouble navigating between different professional contexts

Reducing power differentials helps students feel at ease and more comfortable with the idea of sharing ideas / themselves, you “humanise” the interaction

Students often don’t have a framework for self-evaluation i.e. they don’t know what a 3rd year should be able to do relative to a qualified practitioner. Their frame of reference is limited to themselves and a few teachers whose thinking process exists inside a black box

Correct errors gently, create a space of emotional safety, learning doesn’t happen in an emotional / financial / social / personal vacuum (in another workshop that I attended the other day, the presenter mentioned the “kind teacher”, an idea that I’ve been thinking about a lot)

Predicting the future by understanding the past allows us to look back at our practice and make long term plans for patient management

Enhancing learning in clinical situations

Why is the clinical learning situation so unique? Good place to apply theory, real world scenarios, BUT also a place that can inspire levels of fear that are not present in a classroom

We can ask students to assess their fears i.e. what are they afraid of and why. Then create an environment in which they can confront their fears and see the outcomes of their fears realised e.g. take off the cardio leads and hear the alarm go off, but also see that the patient continues breathing

Educational theories and frameworks can give students a structure for thinking, can help guide their thought processes, but do they necessarily need a deep understanding of the theory e.g. social constructivism?

Creating relationships between pathology and “normal” helps students understand dysfunction. However, this does little to help them develop a management protocol i.e. relate dysfunction to intervention

Facilitating ethical reasoning in student clinical practice. The relationship between ethical principles should be analysed in the light of their impact on the patient

In the early stages of their training, students don’t yet have the language to articulate ethical dilemmas

Feedback to students around ethical dilemmas should acknowledge the experience, but not pass judgement on any of the parties involved

Students often don’t emphasise the moral and ethical components of their practice, as they believe that technical ability is what they will be assessed on (which is true)

Assessment isn’t perfect

Use rubrics to prepare students in terms of providing a framework for their learning

Students won’t expose their weaknesses if they believe that they will be judged on them

Students must be able to act on the feedback given, which means that it must be timeous in order to be relevant

Students need to “learn how to know”

Twitter Weekly Updates for 2011-01-24